Contrast Guidelines for Common CT/CTA MRI/MRA

1 Contrast Guidelines for Common CT/CTA & MRI/MRAU pdated 12/4/12 CLINICAL Guidelines EXAM DESCRIPTION CT/CTA CPT CODES EXAM DESCRIPTION MRI/MRA CPT CODES Abdominal mass CT Abdomen & Pelvis w74177 MRI Abdomen w & wo 74183 Abdominal pain CT Abdomen & Pelvis w74177 MRI Abdomen w & wo 74183 Abscess CT Abdomen & Pelvis w74177 MRI Abdomen w & wo 74183 AppendicitisCT Abdomen & Pelvis w74177 MRI Abdomen and Pelvis w & wo74183 & 72197 Biliary ductal dilatation CT Abdomen & Pelvis w74177 MRI Abdomen w & wo MRCP 74183 & 76376 Cancer staging CT Abdomen w 74160 MRI Abdomen w & wo 74183 CirrhosisCT Abdomen w & wo 74170 MRI Abdomen w & wo (attn liver)74183 Common bile duct stone CT Abdomen w & wo 74170 MRI Abdomen w & wo MRCP 74183 & 76376 ConstipationCT Abdomen & Pelvis w74177 Crohn's disease, inflammatory bowel disease CT Enterography/Small Bowel74177 & 76376 DiarrheaCT Abdomen & Pelvis w74177 Diverticulitis, LLQ pain CT Abdomen & Pelvis w74177 Hemochromatosis MRI Abdomen w & wo (attn liver)74183 HepatitisCT Abdomen w & wo 74170 MRI Abdomen w & wo (attn liver)

2 74183 Liver function test elevation CT Abdomen w & wo 74170 MRI Abdomen w & wo (attn liver)74183 Liver hemangioma, cyst CT Abdomen w & wo 74170 MRI Abdomen w & wo (attn liver)74183 Lymphoma CT Abdomen & Pelvis w74177 Lymphadenopathy CT Abdomen & Pelvis w74177 Pancreatic mass CT Abdomen w & wo 74170 MRI Abdomen w & wo 74183 PancreatitisCT Abdomen w & wo 74170 MRI Abdomen w & wo 74183 Small bowel obstruction CT Abdomen & Pelvis w74177 Weight loss CT Abdomen & Pelvis w74177 CLINICAL Guidelines EXAM DESCRIPTION CT/CTA CPT CODES EXAM DESCRIPTION MRI/MRA CPT CODES Adrenal adenoma /mass/cystCT Abdomen w & wo 74170 MRI Abdomen w & wo 74183 Bladder cancer.

3 Suspected CT Abdomen & Pelvis w74177 Cancer staging CT Abdomen & Pelvis w74177 MRI Abdomen w & wo 74183 Flank pain, renal colic CT Abdomen & Pelvis wo 74176 Hematuria (CT Urogram, CT IVP) CT Hematuria Protocol CT/IVP w & wo74178 MRI Abdomen and Pelvis w & wo74183 & 72197 Hematuria (suspect mass) CT Hematuria Protocol CT/IVP w & wo74178 MRI Abdomen w & wo (attn kidney) 74183 Hematuria (suspect stone) CT Hematuria Protocol CT/IVP w & wo74178 Hydronephrosis, work upCT Abdomen & Pelvis w and/or wo74178 Renal calculus CT Abdomen & Pelvis wo 74176 Renal cyst CT Abdomen w & wo 74170 MRI Abdomen w & wo (attn kidney) 74183 Renal mass or complex cyst CT Abdomen w & wo 74170 MRI Abdomen w & wo (attn kidney) 74183 GastrointestinalGenitourinary Body ImagingMRICTMRICT"w" indicates with IV Contrast , "wo" indicates without IV contrastThese are general Guidelines to assist in requesting exams by Common diagnoses.

4 Please consult with ARA radiologists as needed for clarification or further assistance @ 512 454 5641. Contrast Guidelines for Common CT/CTA & MRI/MRAU pdated 12/4/12 CLINICAL Guidelines EXAM DESCRIPTION CT/CTA CPT CODES EXAM DESCRIPTION MRI/MRA CPT CODES Adenomyosis MRI Pelvis w & wo 72197 Cancer staging CT Abdomen & Pelvis w74177 MRI Pelvis w & wo 72197 Complex adnexal cysts MRI Pelvis w & wo 72197 Cysts MRI Pelvis w & wo 72197 Dermoid CT Pelvis w 72193 MRI Pelvis w & wo 72197 Endometriosis MRI Pelvis w & wo 72197 Pelvic mass, origin uncertain MRI Pelvis w & wo 72197 Uterine fibroid MRI Pelvis w & wo 72197 CLINICAL Guidelines EXAM DESCRIPTION CT/CTA CPT CODES EXAM DESCRIPTION MRI/MRA CPT CODES Asbestosis CT Chest wo 71250 Bronchiectasis Chest for Interstitial Lung Disease, High resolution (CT Chest wo) 71250 Cancer staging CT Chest w 71260 Chest wall mass CT Chest w 71260 MRI Chest w & wo 71552 Compex pleural effusion CT Chest w 71260 COPDC hest for Interstitial Lung Disease, High resolution (CT Chest wo)

5 71250 Hilar fullness CT Chest w 71260 Intersitial lung disease Chest for Interstitial Lung Disease, High resolution (CT Chest wo) 71250 Lung mass, suspected CT Chest w 71260 Lung nodules CT Chest wo 71250 Mediastinal adenopathy CT Chest w 71260 Mediastinal mass CT Chest w & wo 71270 MRI Chest w & wo 71552 Sarcoidosis Chest for Interstitial Lung Disease with Contrast , High resolution (CT Chest w) 71260 CLINICAL Guidelines EXAM DESCRIPTION CT/CTA CPT CODES EXAM DESCRIPTION MRI/MRA CPT CODES Aortic dissection CT Chest w & wo 71270 MRI Chest w & wo 71552 Cardiac anomalies MRI Chest wo 71551 Coronary artery anomalies CTA Coronary w & wo Include 3 D75574 Coronary artery disease CTA Coronary w & wo Include 3 D75574 Coronary artery disease + LV/RV cardiac function CTA Coronary w & wo Include 3 D75574 Pericardial disease CT Chest w 71260 MRI Chest w & wo 71552 Pulmonary vein mapping.

6 Pre ablation CTA Heart Morphology 75572 PulmonaryCTMRIP elvisMRIC ardiacCTMRICT"w" indicates with IV Contrast , "wo" indicates without IV contrastThese are general Guidelines to assist in requesting exams by Common diagnoses. Please consult with ARA radiologists as needed for clarification or further assistance @ 512 454 5641. Contrast Guidelines for Common CT/CTA & MRI/MRAU pdated 12/4/12 CLINICAL Guidelines EXAM DESCRIPTION CT/CTA CPT CODES EXAM DESCRIPTION MRI/MRA CPT CODES Abdominal aortic aneurysm (AAA), suspected CT Angiography Abdomen & Pelvis 74174 MRA Abdomen w or wo 74185 Abdominal aortic aneurysm (AAA)

7 , known CT Angiography Abdomen & Pelvis 74174 MRA Abdomen w or wo 74185 Aortic dissection, Thoracic CT Angiography Chest71275 MRA Chest w or wo71555 Carotid bruit CT Angiography Carotid/Neck70498 MRA Neck w & wo 70549* Carotid stenosis/occlusion CT Angiography Carotid/Neck70498 MRA Neck w & wo 70549* Claudication CT Angiography Abdomen, Pelvis, Lower Ext w runoff75635 MRA Abdomen w & wo and MRA Lower Ext w & wo 74185 & 73725 * Cold feet CT Angiography Abdomen, Pelvis, Lower Ext w runoff75635 MRA Abdomen w & wo and MRA Lower Ext w & wo 74185 & 73725 * Foot ulcer CT Angiography Abdomen, Pelvis, Lower Ext w runoff75635 MRA Abdomen w & wo and MRA Lower Ext w & wo 74185 & 73725 * Hypertension, malignant CT Angiography Renal (Abdomen)

8 W & wo Contrast74175 MRA Abdomen w or wo 74185 Leg edema CT Angiography Abdomen & Pelvis 74174 Peripheral vascular disease legs CT Angiography Abdomen, Pelvis, Lower Ext w runoff75635 MRA Abdomen w & wo and MRA Lower Ext w & wo 74185 & 73725 * Pre op or post op stent graft AAA/Endograft74174 Renal artery stenosis CT Angiography Renal (Abdomen) w & wo Contrast74175 MRA Abdomen w or wo 74185 Coronary Artery DiseaseCT Angiography Coronary 75574 Thoracic aortic aneurysm CT Angiography Chest71275 MRA Chest w or wo71555 MRIV ascularCT"w" indicates with IV Contrast , "wo" indicates without IV contrastThese are general Guidelines to assist in requesting exams by Common diagnoses.

9 Please consult with ARA radiologists as needed for clarification or further assistance @ 512 454 5641. Contrast Guidelines for Common CT/CTA & MRI/MRAU pdated 12/4/12 CLINICAL Guidelines EXAM DESCRIPTION CT/CTA CPT CODES EXAM DESCRIPTION MRI/MRA CPT CODES Abscess MRI Brain w & wo 70553 AVM, vascular malformation MRI Brain w & wo and MRA Head w70553 & 70545 Breast discharge MRI Brain w & wo (Attention to Pituitary) 70553 Cancer staging, Brain MRI Brain w & wo 70553 Cancer staging, Neck CT Soft tissue neck w 70491 MRI Orbit, Face, & Neck w & wo 70543 Carotid stenosis/occlusion CT Angiography Carotid/Neck70498 MRA Neck w & wo 70549 Sinus congestion/drainageCT Limited sinus wo70486 52 Chronic sinusitis CT Complete sinus wo70486 Change in mental status CT Brain wo 70450 MRI Brain w & wo 70553 Cranial neuropathy MRI Brain w & wo and MRI Orbit , Face, Neck w & wo70553 & 70543 Dementia MRI Brain wo70551 Dizziness, syncope MRI Brain wo70551 Dizziness.

10 Syncope with cancer historyMRI Brain w & wo 70553 Headache, acute onset CT Brain wo 70450 MRI Brain wo70551 Headache, acute onset with cancer historyCT Brain w & wo 70470 MRI Brain w & wo 70553 Migraines MRI Brain wo70551 Migraines with cancer historyMRI Brain w & wo 70553 Headaches, subacute or chronic MRI Brain wo70551 Diplopia MRI Brain w & wo and MRI Orbit , Face, Neck w & wo70553 & 70543 Family history intracranial aneurysm CT Angiography Brain/Head70496 MRI Brain w & wo 70553 Fracture facial, orbital CT Maxillofacial Bones wo70486 Glioma MRI Brain w & wo 70553 Hearing loss, conductive CT Temporal Bones wo 70480 Hearing loss, sensorineural MRI Brain w & wo (Attn to Internal Auditory Canal) 70553 Hoarseness CT Soft tissue neck w 70491 Intracerebral artery stenosis/occlusion CT Angiography Brain/Head70496 MRA Brain w70545 Intracranial hemorrhage, acute CT Brain wo